Vertebral Artery Dissection Collaterals

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Patient with proximal right Vertebral Artery (VA) dissection. VA is occluded from origin till C5 level (arrowhead on last image). Patient suffered from right cerebellar and left occipital infarct. Right VA is dominant (as anatomical variant) since left VA ends in Posterior Inferior Cerebellar Artery (PICA). Note on those 3D reconstructions the collateral circulation. First two images show Deep Cervical Artery branch that originates from Costocervical Trunk and enters VA cranial to C1 arch (arrow). Third and fourth images show another collateral: Ascending Cervical Artery that originates from Thyrocervical Trunk and enters VA through the vertebral foramen at the level of C2-3 (long arrow on last image).

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